Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
Department of cardiology, Golden Jubilee National Hospital, Glasgow, UK.
Catheter Cardiovasc Interv. 2024 Nov;104(6):1178-1188. doi: 10.1002/ccd.31222. Epub 2024 Sep 29.
Angiography-derived fractional flow reserve (virtual FFR) has shown excellent diagnostic performance compared with wire-based FFR. However, virtual FFR pullback curves have not been validated yet.
To validate the accuracy of virtual FFR pullback curves compared to wire-based FFR pullbacks and to assess their clinical utility using patient-reported outcomes.
Pooled analysis of two prospective studies, including patients with hemodynamically significant (FFR ≤ 0.80) coronary artery disease (CAD). Virtual and wire-based FFR pullbacks were compared to assess the accuracy of virtual pullbacks to characterize CAD as focal or diffuse. Pullbacks were analyzed visually and quantitatively using the pullback pressure gradient (PPG). Patients underwent PCI, and the Seattle Angina Questionnaire (SAQ) was administered at 3-month follow-up.
A total of 298 patients (300 vessels) with both virtual and wire-based pullbacks who underwent PCI were included in the analysis. The mean age was 61.8 ± 8.8, and 15% were female. The agreement on the visual adjudication of the CAD pattern was fair (Cohen's Kappa: 0.31, 95% confidence interval: 0.18-0.45). The mean PPG were 0.65 ± 0.18 from virtual pullbacks and 0.65 ± 0.13 from wire-based pullbacks (r = 0.68, mean difference 0, limits of agreement -0.27 to 0.28). At follow-up, patients with high virtual PPG (>0.67) had higher SAQ angina frequency scores (i.e., less angina) than those with low virtual PPG (SAQ scores 92.0 ± 14.3 vs. 85.5 ± 23.1, p = 0.022).
Virtual FFR pullback curves showed moderate agreement with wire-based FFR pullbacks. Nonetheless, patients with focal disease based on virtual PPG reported greater improvement in angina after PCI.
血管造影衍生的血流储备分数（虚拟 FFR）与基于导丝的 FFR 相比显示出出色的诊断性能。然而，虚拟 FFR 回撤曲线尚未得到验证。
验证与基于导丝的 FFR 回撤相比，虚拟 FFR 回撤曲线的准确性，并使用患者报告的结果评估其临床效用。
对两项前瞻性研究进行汇总分析，包括血流动力学意义重大（FFR≤0.80）的冠心病患者。比较虚拟和基于导丝的 FFR 回撤，以评估虚拟回撤准确识别局灶性或弥漫性 CAD 的能力。通过回撤压力梯度（PPG）进行视觉和定量分析。患者接受 PCI 治疗，并在 3 个月随访时进行西雅图心绞痛问卷（SAQ）评估。
共纳入 298 例（300 支血管）接受虚拟和基于导丝的 FFR 回撤且接受 PCI 的患者进行分析。患者平均年龄为 61.8±8.8 岁，15%为女性。CAD 模式的视觉判断一致性为中等（Cohen's Kappa：0.31，95%置信区间：0.18-0.45）。虚拟回撤的平均 PPG 为 0.65±0.18，基于导丝的回撤为 0.65±0.13（r=0.68，平均差值 0，一致性界限-0.27 至 0.28）。在随访时，高虚拟 PPG（>0.67）的患者 SAQ 心绞痛发作频率评分（即心绞痛发作较少）高于低虚拟 PPG 的患者（SAQ 评分 92.0±14.3 比 85.5±23.1，p=0.022）。
虚拟 FFR 回撤曲线与基于导丝的 FFR 回撤具有中等一致性。然而，基于虚拟 PPG 的局灶性疾病患者在 PCI 后心绞痛改善更大。
